Owner Surrender Form

  • We will need a photo of your dog for the web site, please keep the file size < 200KB
  • Please write information about your dog you think is important.
  • How is your dog with children?
  • How is your dog with other dogs?
  • How is your dog with cats?
  • How is your dog with small animals like rabbits, hamsters, fish, birds etc?
  • Please select the option that best describes your dog's housebreaking training.
  • What breed is your dog?
  • You can provide a second photo if you wish, please keep the file size < 200KB
    Please check all that apply to your dog's training.
    Please check off all the areas where your dog needs training or has caused troubles
  • If you live outside of PA, NJ, DE, or MD, you will have to contact us to discuss your situation
  • Please explain why you must find a new home for your dog.
  • Tell us more about your dog.
  • Has your dog ever bitten? If not, please indicate here. If yes, please explain the circumstances.
  • Please select, keep in mind the longer you can hold, the more likely we can help.
  • You must validate the information presented here.
  • Please select the terms that apply to your situation.
  • Please provide your current vet name, address, and phone number.
  • When was your dogs last rabies vaccine (month/year)?
  • When was your dogs last distemper combo vaccine (DHLP, DP, Etc)?
  • When was your dog last tested for heartworm and what was the result?
  • List any known medical problems with your dog.
  • If microchipped, enter number here.
  • After clicking on Submit, DO NOT REFRESH or RESUBMIT. You will receive a confirmation message (and email) if you successfully submitted this surrender form. If the form still appears, review for missing Required fields and enter the requested information.